Insights

“Follow the Leader” isn’t always a game that should be played during quality improvement (QI) work. In fact, often, QI teams need to be proactive about engaging their leaders, creating a partnership to support change initiatives. To do that, leaders might have to be pushed out of their comfort zones.

“Most people don’t naturally embrace change, and that includes leaders,” says NICHQ’s Director of Programs Meghan Johnson, MSc. “About 70 percent of change programs fail. Change efforts in healthcare are no more likely to succeed than they are in other fields. However, leadership engagement is one of the key predictors and a correlate of success.”

To generate buy-in for change, one needs to understand their leader’s motivation and desire for the specific type of change targeted by the QI work.

The Right Motivation

Because every leader has unique motivators for promoting and participating in any initiative, one should learn about their leader’s personality. Some questions to ask include:

What is the leader’s personality type? (e.g., sociable, precise, competitive)

How does the leader respond to information? (e.g., enthusiastically, cautiously)

What convinces this person? (e.g., numbers, stories)

What do they respond most to? (e.g., data, innovation, trends)

This information will steer the QI team towards the right tools and approaches to use when discussing a project. For instance, an analytical leader would probably be more motivated by data than anything else, so search for statistics that support the change effort. On the other hand, a more cautious leader might require a full picture of expected and unintended outcomes in order to feel comfortable before moving forward.

Even in cases when leaders are supportive and enthusiastic, the right tools and proper framing of the work can lead to higher engagement, which can result in a successful, long-term change.

The Desire for Change
“The second thing when thinking about your leader’s style is to understand their appetite for change,” according to Johnson.

She used Everett Rogers’ diffusion of innovation curve to highlight the five groups leaders will likely fall into. Understanding a leader’s attitude will also unveil some potential solutions for approaching them about change and QI work:

Innovators – This is a small minority who wants to expand into new horizons. For innovators to be engaged, the proposed idea and strategy for implementation need to have positive expected results and be unlike previous work done within the organization.

Early Adopters – A slightly larger group who are more likely to support change when it aligns with the organization’s overall goals. Where innovators encourage and welcome new ideas to evolve current operations, early adopters are more judicious in what they support. To approach them, QI teams should create connections between QI and how it’ll benefit everyone within the organization in both the short and long terms.

Early Majority –This large group will follow change that yields positive results, but aren’t usually champions for innovation. Instead, leaders in this category wait to see some results before opting to change. In this case, teams need to show evidence of past success to engage their leaders.

Late Majority – A group who is more skeptical and resistant to change, and needs to see that there’s already support for change within the organization and across the field as a whole. With late-majority leaders, change needs to have momentum from key decision makers and be popular with other organizations in the same industry. Late-majority leaders are cautious, but ultimately don’t want to fall too far behind their peers.

Laggards – This is a small minority, because most leaders aren’t laggards who value past success and traditional methods over change. To convince laggards to buy-in to change, ideas should be tied to previous work to demonstrate similarities between them and highlight potential progress.

As with leadership’s personality, measuring and understanding the current attitude towards change will affect each change initiative. There will never be a universal method of gaining engagement and buy-in, and understanding a leader’s personality is only the start of developing the appropriate approach.